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Contraception for undergraduate

1.
contraception
DR Manal Behery
2014

2.
Definition of Contraception
• Contraception = “Against Conception”
• The intentional prevention of pregnancy
through the use of various devices, agents,drugs,
sexual practices or surgical procedures.

5.
Top five factors to consider when selecting a
method of fertility control.
•Cost
•Effectiveness of protections from STDs
•Safety and side effects
•Comfort and ease of use
•Reversibility and future fertility

6.
The only 100% effective way to
prevent pregnancy and STD
is to be sexually
Abstinent
or to Postpone
sexual involvement.

12.
Mini-pill
• Contains only progestin
• Used continuously 28 days
• Effect: thickens the cervical
mucus and makes the lining
of the uterus less receptive
to implantation
• Indicated because of
medical reasons and women
breatsfeeding

17.
Taking the Pill
• Once a day at the same time everyday
• Use condoms for first month
• Use condoms when on antibiotics
• Use condoms for 1 week if you miss a pill or take
one late
• The pill offers no protection from STD’s

18.
Injection or "shot"—
• Women get shots of the
hormone progestin in the
buttocks or arm every
three months from their
doctor.
• It is 97–99% effective at
preventing pregnancy.

26.
Contraceptive implants
• Slow release of a progestin
over a period of three years
• Effect: prevents the release of
the egg from the ovary
(ovulation); promotes thick
cervical mucus
• Application: inserted in the
upper arm under local
anesthesia
• Side effects: irregular
bleeding
• Pro: fertility rapidly returns

27.
Implanon
• Contains 68 mg etonogestrel
• Single rod implanted subdermally on day 1-5 of
cycle
• Last for 3 years.
• Works by thickening cervical mucus and also
inhibits ovulation
• Extremely effective in pregnancy prevention >
99%
• Irregular bleeding common side effect

29.
Emergency Contraception (ECP)
• Must be taken within 72 hours of the act of
unprotected intercourse or failure of contraception
method
• Must receive ECP from a physician
• 75 – 84% effective in reducing pregnancy

30.
How EC ACT?
• Floods the ovaries with high amount of hormone
and prevents ovulation
• Alters the environment of the uterus, making it
disruptive to the egg and sperm
• Two sets of pills taken exactly 12 hours apart

34.
Vaginal Ring (NuvaRing)
• 95-99% Effective A new ring is inserted into the vagina each
month
• Does not require a "fitting" by a health care provider,
• does not require spermicide, can make periods more regular and
less painful,
• no pill to take daily, ability to become pregnant returns quickly
when use is stopped.

56.
DIAPRAGHM
• Perfect Effectiveness Rate = 94%
• Typical Effectiveness Rate = 80%
• Latex barrier placed inside vagina during
intercourse
• Fitted by physician
• Spermicidal jelly before insertion
• Inserted up to 18 hours before intercourse and can
be left in for a total of 24 hours

57.
DIAPHRAGM
The diaphragm is a flexible rubber cup that is filled with
spermicide and self-inserted over the cervix prior to
intercourse. The device is left in place several hours
after intercourse. The diaphragm is a prescribed device
fitted by a health care professional and is more
expensive than other barrier methods, such as condoms

59.
CERVICAL CAP
• Latex barrier inserted in vagina before intercourse
• “Caps” around cervix with suction
• Fill with spermicidal jelly prior to use
• Can be left in body for up to a total of 48 hours
• Must be left in place six hours after sexual
intercourse
• Perfect effectiveness rate = 91%
• Typical effectiveness rate = 80%

60.
Cervical Cap
The cervical cap is a flexible rubber cup-like device that is filled with
spermicide and self-inserted over the cervix prior to intercourse. The
device is left in place several hours after intercourse. The cap is a
prescribed device fitted by a health care professional and can be more
expensive than other barrier methods, such as condoms.

61.
Sponge
The sponge is inserted by the woman into the vagina and covers the
cervix blocking sperm from entering the cervix. The sponge also
contains a spermicide that kills sperm. It is available without a
prescription

63.
Intrauterine Devices (IUD)
• T-shaped object placed in the
uterus to prevent pregnancy
• Must be on period during
insertion
• A Natural childbirth required to
use IUD
• Extremely effective without using
hormones > 97 %
• Must be in monogamous
relationship

64.
What are the most cu ( IUD ) used today ?
Today two types of cu IUD are used mostly Multiload
(left) and cupper T (right) :

65.
Levonorgestrel Intrauterine system
• The LNG IUS is made of flexible plastic
• The LNG IUS contains a progestin hormone
called levonorgestrel which has been used
in birth control pills since the 1970s
• The safety of levonorgestrel has been
proven by clinical use also in sub-dermal
implants and intrauterine systems since
decades

67.
LNG IUS ENDOMETRIAL EFFECTS
Ovulation
Ovulation
Menstruation
Days of the menstrual cycle Days of the menstrual cycle

68.
Who can and cannot use the IUD
Most women can safely
use the IUD
But usually cannot use IUD if :
• May be
pregnant
• Gave birth
recently
(more than 2
days ago)
• Unusual
vaginal
bleeding
recently
• At high risk for
STIs
• Infection or
problem in
female organs

70.
Possible side-effects
If you choose this method, you may have some side-effects.
They are not usually signs of illness.
After insertion:
• Some cramps
for several
days
• Some spotting
for a few weeks
Other common side-effects:
• Longer and
heavier periods
• Bleeding or
spotting between
periods
• More cramps or
pain during
periods
May get less after a few
How would you feel months
about these side-effects?

71.
What will happen when
Steps:
you get your IUD
Pelvic examination
Cleaning the vagina and cervix
Placing IUD in the womb
through the cervix
• May hurt at insertion
• Please tell us if it hurts
• Rest as long as you like
afterwards
• May have cramps for several
days after insertion



Afterwards:
you can check
your IUD from
time to time
Are you ready to
choose this method?
What questions do
you have?

72.
What to remember
• Your kind of IUD:
• When to have IUD taken out:
• Bleeding changes and
cramps are common. Come
back if they bother you.
• Come back for a check-up in 3 to
6 weeks or after next menstrual
period
See a nurse or doctor if:
• Missed a
menstrual
period, or
think you
may be
pregnant
• Could have an
STI or
HIV/AIDS
• IUD strings
seem to
have
changed
length or are
missing
•Bad
pain in
lower
abdomen
Anything else I can
repeat or explain?
Any other questions?

74.
TUBAL LIGATION
• Surgical procedure performed on a woman
• Fallopian tubes are cut, tied, cauterized, prevents eggs from reaching sperm
• Failure rates vary by procedure, from 0.8%-3.7%
• May experience heavier periods
Surgical sterilization which
permanently prevents the
transport of the egg to the uterus
by means of sealing the fallopian
tubes is called tubal ligation,
commonly called "having one's
tubes tied." This operation can be
performed laparoscopically or in
conjunction with a Cesarean
section, after the baby is delivered.
Tubal ligation is considered
permanent, but surgical reversal
can be performed in some cases

77.
During a vasectomy (“cutting the vas”) a urologist cuts
and ligates (ties off) the ductus deferens. Sperm are still
produced but cannot exit the body. Sperm eventually
deteriorate and are phagocytized. A man is sterile, but
because testosterone is still produced he retains his sex
drive and secondary sex characteristics.

80.
WITHDRAWAL
• Removal of penis from the vagina before ejaculation occurs
• NOT a sufficient method of birth control by itself
• Effectiveness rate is 80% (very unpredictable in teens, wide variation)
• 1 of 5 women practicing withdrawal become pregnant
• Very difficult for a male to ‘control’